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Fern's found the right way to lose weight
By Dr Mark Potter, Evening Standard Last updated at 14:26pm on 03.06.08
Incredible shrinking woman: since her gastric band operation two years ago Fern Britton has dropped four dress sizes
Fern Britton's admission that her recent weight loss is the result of surgery, rather than willpower and a rigorous diet and exercise programme, serves to illustrate two points all too familiar to most doctors. Namely, that despite their protestations that they are fat and happy, no obese person is truly content with their shape, and that diet, exercise and even slimming drugs simply do not work for most people.
If you really need to drop four dress sizes, as Fern has, then surgery is probably the most effective option. But is it right that a cash-strapped NHS should fund such a drastic solution?
It is a controversial issue but there is a growing feeling among doctors that gastric surgery is much under-used in this country. In an ideal world obesity should be treated simply by encouraging a healthier lifestyle, but in practice the results from this sort of intervention are depressingly poor. And prescription-only slimming drugs don't seem to add much, either - weight loss using them is often disappointing and is reversed within a few months of the patient stopping therapy.
In 2002, when the National Institute of Health and Clinical Excellence (NICE) first appraised surgical treatments for obesity (bariatric surgery) there were fewer than 10 specialists in the country offering the treatment, compared with around 200 in countries like France and Italy where obesity rates are significantly lower.
The situation is improving here but not as fast as some experts would like. There are thought to be at least a million people in England and Wales alone who meet the criteria for bariatric treatment suggested by NICE (see below), yet just 3,000 operations are likely to be carried out during the current financial year.
No primary care trust (PCT) in the country will openly admit to refusing to fund bariatric surgery but only half rigidly apply the criteria laid down by NICE, with most setting the bar much higher. It is unclear why they are so reluctant given that NICE believes it makes financial sense in carefully selected patients. It concluded that the short-term costs - around £6,000 per patient for gastric banding (the most widely used procedure) - are balanced in the longer term by a reduction in obesity-related complications such as heart disease, cancer and diabetes.
And the resulting weight loss is pretty impressive too. Bariatric surgery remains by far the most successful of all the interventions offered by the NHS. Fern lost five stone, but results are often even more dramatic than that and the weight loss is often permanent. Something that can't be said for people who follow low-calorie diets or take slimming pills - most of whom eventually end up back at their original weight within a year or two.
It may be an effective solution, but it has more than its fair share of complications and it is no panacea. As Anne Diamond discovered to her dismay, it doesn't work for everyone, and there are significant risks involved. Although gastric banding is done using a minimally invasive keyhole technique, it still requires a general anaesthetic and the risks of complications like chest infections and blood clots are much higher in the very obese.
That said, most operations go smoothly and serious complications are unusual, and have to be balanced against the benefits - many of these patients won't be alive if they don't have the surgery.
Even so, bariatric surgery is always going to be very hard to get on the NHS, with fewer than one in 400 of those eligible under the NHS criteria being offered it in any one year, at a cost of around £20 million. To even be considered, NICE recommends that you should be:
• aged 18 or over
• be morbidly obese with a body mass index of 40 or above (or 35 and above if you already have a health problem such as diabetes or high blood pressure that would be helped by weight loss).
• been under the care of a specialist at an obesity clinic and have tried and failed to lose weight using conservative methods (diet, exercise and prescription-only slimming medication).
Around half of all operations done in the UK this year will be performed privately - gastric banding costs around £7,000 a go and most surgeons apply exactly the same criteria to their NHS and private patients, so don't expect to be able to get it done unless you have a serious weight problem.
Reader views (9)
fern you look fantastic! take no notice of others your still loved and youve done really well be proud of your self. me and my husband have been to have all the tests and now we go back the hospital on the 30th jan 2009 to get the results and hopefully an operation date for the gastric band on the nhs so im really excited because we need to loose a lot of weight the doctor suggested the bypass then realized i want a baby so its got to be the band so it can be adjusted ive got no children and im 35 and ive got to loose weight to even get pregnant i allready lost a baby when i was 6mths pregnant in 1995 through prclampsia hi have high blood preasure aswell so its got to be done i cant wait to loose weight and be healthy ive really got my head into this because of fern shes great and us viewers have watched her on tv with her weight problem so hats off to you this is a chance not to be missed i feel honered to get this on the nhs.
- Yvonne Bloor, blackpool lancashire
Fern!!!! Ignore all those do gooders. I and my wife agree with you 100% the decision to go ahead was YOURS and your husband.It's no-one else's business. Good on you you look blooming wonderful. Well done. Stay fit and happy we all love you.
- Max And Marian Hurni, Stoke on Trent Staffs England
I wonder why people like Fern don't disclose the fact that they have done something at long last to help them shed the lbs. Do they think that we haven't tried every diet going, and yes I am the first to admit that I have no self control. People like Paul, Ian and Diana have obviously not got any problems in their lives that they need a hand to sort out. Good for them!! Fern should have kept quiet about her operation if such rude people as those three are around.
- Barbara Hines, Wokingham Berkshire
I had a gastric band fitted in Dec. 07 which I paid for myself £8,000. I tried to get NHS funding but West Berkshire Ptc had set their criteria far higher than anywhere else in the country I believe. They said that my BMI should be over 50 (35/40 in other areas) that I needed to be diabetic and disabled throughout my weight problems. They didn't take into account that I had severe sleep apnoea, high blood pressure etc.
I could only afford to have this operation done because I had been left some money when my mum died last year.
Gastric weight loss surgery is not something you go into lightly, as it effects your life in many ways. You still have to 'diet', by eating low cal, low fat food, only now you physically cant eat more than a tea cupful of food at one time. You can still eat things like chocolate, biscuits etc. as they go down easily, so you still have to have the 'will power' not to eat junk. Most people who are obese like me have spent a lifetime overeating and enjoying eating, so post surgery to sit down to a meal and being full after 3 or 4 fork fulls makes you feel deprived, especially when everyone else is still tucking in. You have to learn new ways of eating, like very small pieces, and chewing lots and lots, putting your cutlery down while you chew. etc.
My surgery went well, and I have lost 4.5 stone since Dec. 07.
Is it money well spent? Yes of course it is! My sleep apnoea is improved. As is my blood pressure, I hope to come off of medication soon.
- Barbara Hines, Wokingham Berkshire
Why is everyone vilifying this woman? OK I agree she should have been more honest when doing photo-shoots and interviews, but she was clearly struggling with her weight and sort help. Give her some credit, exercise and diet also plays a part. There shouldn't be shame in asking for some help, especially when the health benefits are enormous. Of course, it should only be a last measure and will-power where possible should be used rather than surgical procedures. I don't understand all this bitterness towards her though. Perhaps from the overweight camp or people who aren't so happy with their own weight but don't do anything about it?
- Kitty, London
I wish the NHS would focus more on preventative medicine. I paid to have a gastric band operation privately in Belgium. Not only was it cheaper, the surgeon was a specialist and had performed hundreds of operations. The hospital did not have MRSA or C Diff problems either-all of which need to be factored in when deciding to go under the knife.
The results have been slow and steady, with my fair share of setbacks along the way. It is not an easy option, but it is very effective. I have lost weight many times in the past-only to gain it all back again plus an additional stone.
This time, because the band is a permanent fixture, I expect to remain at a healthy weight for the rest of my life. My knee problems have cleared up and I have been able to take up running. I have never been this fit, even when I was in school. Hopefully I have avoided all the illnesses which are caused by obesity. I have helped myself as have all those who have gone down the gastric band route. We should all be congratulated and supported.
- Sue Mcdermott, Beaconsfield
The best way forward is not to get so fat in the first place. It must really make people being denied cancer drugs feel good when they see calls to make more funding available to help out fatties.
- Paul, London
It looks as though she got fat in the first place because her breasts are very large. I must say that they look terrific, but if you had to carry those around, the ability to do any exercise must be severely restricted. The NHS should make surgery available to women in their late teens who wish to shed a lot of pounds and get in shape, by offering breast reduction.
- Ian, Vancouver, Canada
It will be much more cost effective than funding bariatric surgery in the future, to programme the brain via a microchip to control the individuals eating patterns - You can't exactly say it's completely non-invasive but as the brain plays the leading part in all that we do, I feel we are going to use this method of control in the future in every area necessary to help individuals to reform- after all a gastric band is also a method of control to help change the individuals eating habits and not a very pleasant operation I am sure.
- Diana, Torquay
